9 Topics Women Over 50 Bring Up Most In Sex Therapy

Sex during the menopause can be a time of rediscovery for some, as changes like vaginal dryness and decreased sensitivity begin.

But, as the NHS says, the idea that your sex life dies out after your hormones shift is a “myth”.

Sexologist, relationship therapist, and author at Passionerad, Sofie Roos, told us that the women she sees in their 50s and beyond bring a wide range of topics to her door.

Here are just some of the concerns she regularly hears from this group, as well as what to do if you’re dealing with them:

Lower libido is common among menopausal and postmenopausal women, though hormone replacement therapy (HRT) can sometimes help.

“It’s so common to experience lower sexual desire as you get older… due to hormonal changes and the menopause, but also because you’re experiencing stress, lack of sleep, relationship problems, or are on medications,” Roos told us.

Often, she added, it’s down to a combination of multiple factors. And, the sexologist said, it’s “common for this group to be worried about [whether] their lust [level] is normal, or if there’s something wrong with them”.

Discomfort and pain during penetrative sex is officially called dyspareunia, and it’s common among women aged 50 and over.

“The bodily changes that come with the menopause often makes the vagina dryer and more sensitive, a combination that makes it more difficult to have penetrative sex in a pleasurable way,” Roos stated.

The pain can lead to a vicious cycle, she explained, as it might make you unable to relax, which means you tense up, and may then avoid penetration due to the discomfort.

“An ageing body often means a changed body,” the sexologist said, noting it can alter your weight, body shape and skin, which can all affect body image.

This, in turn, can make it hard for some to stay present during sex, as they’re consumed by thoughts of their own appearance.

“Sometimes, the issue is less about the sex itself, but rather about [a woman’s] relationship to [their] own body,” said Roos.

About 20% of menopausal women reported less frequent and/or intense orgasms in a 2024 paper. Roos describes this as “a very common issue” that women over 50 come to her with.

She added: “What used to make them climax doesn’t work any longer; they orgasm less often, it takes longer time to get there, and the orgasms don’t feel as pleasurable.”

Your partner’s desire might not wane or rise at the same time as yours, Roos pointed out.

While this discrepancy can happen “at all ages, it can [be] extra obvious for women when getting older, especially if they experience major changes in their body while their partner doesn’t”.

This, she added, is very common in heterosexual relationships, “as the man doesn’t go through menopause and often starts experiencing sexual struggles a bit later in life”.

On the flip side, some women experience more lust as they age, right as their partner might begin facing erectile dysfunction or other sexual challenges.

For some women, “sex therapy is less about orgasms or penetration, but more about finding [their way] back to the emotional closeness and everyday intimacy” they once had with their partner, said the expert.

She suggested that after many years together, some of the women she supports want advice on how to find their way back to feeling like a romantic couple, rather than just friends or roommates.

Though lots of women divorce in their 40s, a growing number split in their 50s, Roos shared. Re-entering the dating market after what may be many years out of it “makes questions about sex, new relationships and dating relevant again”.

Some women in menopause or perimenopause report a “sex surge”, or a sudden leap in physical desire, during this life stage.

Roos suggested many of them “have the idea that their sex lust should decline when hitting 50, which makes some middle-aged women with a high sex drive worried [that] there’s something wrong with them”.

“But I really want to highlight that there’s no right [or] wrong when it comes to sexual desire after 50,” she added.

The sexologist offered some general guidelines and advice for women over 50:

• There’s nothing wrong with you for facing changes: “The first step is always to make peace with the fact that changes in sexuality are normal and natural, as well as nothing that isn’t solvable.”
• Always take pain during sex seriously: “Sex should never hurt, so if you experience new or ongoing pain, it’s important to always seek professional help… Sometimes, it can be as easy as starting to use a good lube and vaginal moisturisers, or to explore other kinds of intimacy, while medical treatments are relevant in other cases.”
• Let go of the idea that sex always has to mean penetration: “If it doesn’t work for you, then invest more time and energy into oral and [digital] sex, kisses, roleplaying, the use of sex toys or anything else that you find thrilling.”
• Spend more time on foreplay: As we age, “it takes longer for the body to get ready for sex,” so building up desire slowly can be helpful.
• Give sex toys a go, especially if you have trouble reaching orgasm: “An air pulse vibrator is a lovely start,” Roos said.
• Talk openly about your lust: “Many people think that lust just pops up out of nowhere,” said the expert, yet most people have responsive desire, which means “you get in the mood after touch and closeness is initiated”. Therefore understanding your lust better will help you to have more joyful sex.
• Try to avoid criticism: Have “an open and honest chat with your partner about what you miss and are longing for, rather than focusing on what you or your partner is doing ‘wrong’,” said the expert.
• Take care of your overall health: “It really makes a difference to eat a balanced diet, do some cardio three to four times a week, drink less, give up smoking, and invest in better sleep, stress control, and your relationships.”
• Seek help if needed: You don’t have to accept pain, vaginal dryness, or other sexual issues just because you’ve passed 50, so don’t be put off from seeking help from a professional.

The sexologist ended that sexual health isn’t about performing, but is more about feeling “safe, free and comfortable”.